@layout("/common/_container.html"){
<!--startprint1-->
<style>
    p {
        margin: 0;
    }

    label {
        font-weight: 500;
    }

    #hospital {
        border: 1px solid #666666
    }

    #hospital_log, #patient {
        text-align: center;
    }

    #hospital_log > h1, #patient > h2 {
        margin: 0;
        padding: 15px;
        color: black;
    }

    #records_information, #records_details {
        border-top: 1px solid #666666;
    }

    #records_one, #records_two, #records_thr, #records_for  {
        border-bottom: 1px solid #666666;
        display: flex
    }

    #records_one > div, #records_two > div, #records_thr > div , #records_for > div {
        flex: 1;
        padding: 5px 10px;
    }

    #records_one > div:nth-child(2), #records_two > div:nth-child(2), #records_thr > div:nth-child(2), #records_for > div:nth-child(2) {
        border-left: 1px solid #666666;
        border-right: 1px solid #666666;
    }

    #records_details > div {
        display: flex;
        border-bottom: 1px solid #666666;
        align-items: center;
    }

    #records_details > div > div:first-of-type {
        flex: 1;
        text-align: center;
        padding: 15px 10px;
    }

    #records_details > div > div:last-of-type {
        flex: 5;
        border-left: 1px solid #666666;
    }

    .pay_list_c1 {
        display: inline-block;
        width: 15px;
        height: 15px;
        background: #DCDCDC;
        border: 1px solid #535353;
        border-radius: 5px;
        vertical-align: middle;
        position: relative;
    }

    .radioclass {
        opacity: 0;
        cursor: pointer;
        -ms-filter: "progid:DXImageTransform.Microsoft.Alpha(Opacity=0)";
        filter: alpha(opacity=0);
    }

    #records_visit > div > div, #records_status > div > div, #records_history > div > div, #records_allergy > div > div, #records_anaesthesia > div > div,
    #records_requirement > div > div, #records_source > div > div {
        border-bottom: 1px solid #666666;
        display: flex;
        padding: 3px 15px;
    }

    #records_visit > div > div:last-of-type, #records_status > div > div:last-of-type, #records_history > div > div:last-of-type, #records_allergy > div > div:last-of-type,
    #records_anaesthesia > div > div:last-of-type, #records_requirement > div > div:last-of-type, #records_source > div > div:last-of-type {
        border-bottom: none;
    }

    #records_visit > div > div > span, #records_status > div > div > span, #records_history > div > div > span, #records_allergy > div > div > span,
    #records_anaesthesia > div > div > span, #records_requirement > div > div > span, #records_source > div > div > span {
        flex: 1;
    }
    .aHook{position: absolute;font-size: 24px;  top:-9px;left:0;display: none}
</style>

<div style="display: none">
    <input type="hidden" id="medicalReasonsValue" value="${customerInfo.medicalReasons}">
    <input type="hidden" id="selectReasonsValue" value="${customerInfo.selectReasons}">
</div>

<div class="ibox float-e-margins ">
    <div class="ibox-content record_box">
        <div style="display: none">
            <input type="hidden" id="customerIdValue" value="${customerId}">
        </div>
        <div id="hospital">
            <div id="hospital_log" style="position: relative">
                <h1>湖北咿呀口腔医院病历</h1>
                <span style="position: absolute;right: 30px;top: 50%;transform: translateY(-50%);">${customerInfo.yellowNumber}</span>
            </div>
            <div id="records_information">
                <div id="records_one">
                    <div><span>姓名：</span><span>${customerInfo.customerName}</span></div>
                    <div><span>性别：</span><span>${customerInfo.sex}</span></div>
                    <div><span>病历编号：</span><span>${customerInfo.medicalRecordNumber}</span></div>
                </div>
                <div id="records_two">
                    <div><span>手机：</span><span>${customerInfo.customerPhone}</span></div>
                    <div><span>地址：</span><span>${customerInfo.province}-${customerInfo.cities}-${customerInfo.region}</span></div>
                    <div><span>微信号：</span><span>${customerInfo.wechatNumber}</span></div>
                </div>
                <div id="records_thr">
                    <div><span>职业：</span><span>${customerInfo.occupation}</span></div>
                    <div><span>电话：</span><span>${customerInfo.customerAge}</span></div>
                    <div><span>Email：</span><span></span></div>
                </div>
                <div id="records_for">
                    <div><span>出生：</span><span style="margin-left: 30px">年</span><span style="margin-left: 20px">月</span><span style="margin-left: 20px">日</span><span style="margin-left: 20px">${customerInfo.customerAge}岁</span></div>
                    <div><span>国籍：</span><span></span></div>
                    <div><span>工作单位：</span><span></span></div>
                </div>
            </div>
            <div>
                <p style="margin: 0;padding: 10px;text-align: center">病史</p>
            </div>
            <div id="records_details">
                <div id="records_visit">
                    <div>就诊原因</div>
                    <div>
                        <div>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input
                                        class="radioclass" type="radio" id="inspect" name="reason" value="检查" /></span>
                                    <label class="required" for="inspect" style="">检查</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="filming" name="reason"
                                                                                                       value="拍片"/></span>
                                    <label class="required" for="filming" style="">拍片</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="scaling" name="reason"
                                                                                                       value="洁牙/牙龈出血"/></span>
                                    <label class="required" for="scaling">洁牙/牙龈出血</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="scars" name="reason"
                                                                                                       value="祛疤色素"/></span>
                                    <label class="required" for="scars">祛疤色素</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="whitening" name="reason"
                                                                                                       value="美白"/></span>
                                    <label class="required" for="whitening">美白</label>
                            </span>
                        </div>
                        <div>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="toothFilling" name="reason"
                                                                                                       value="补牙"/></span>
                                    <label class="required" for="toothFilling">补牙</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="toothache" name="reason"
                                                                                                       value="牙疼"/></span>
                                    <label class="required" for="toothache">牙疼</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="toothExtraction" name="reason"
                                                                                                       value="拔牙"/></span>
                                    <label class="required" for="toothExtraction">拔牙</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="trauma" name="reason"
                                                                                                       value="折断/折裂/外伤"/></span>
                                    <label class="required" for="scars">折裂/外伤</label>
                            </span>
                            <span></span>
                        </div>
                        <div>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="toothLoosening" name="reason"
                                                                                                       value="牙齿松动"/></span>
                                    <label class="required" for="inspect">牙齿松动</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="swelling" name="reason"
                                                                                                       value="肿胀"/></span>
                                    <label class="required" for="swelling">肿胀</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="wisdomTooth" name="reason"
                                                                                                       value="智齿发炎"/></span>
                                    <label class="required" for="scaling">智齿发炎</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="toothLoss" name="reason"
                                                                                                       value="牙齿缺失"/></span>
                                    <label class="required" for="toothLoss">牙齿缺失</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="plant" name="reason"
                                                                                                       value="想做种植"/></span>
                                    <label class="required" for="plant">想做种植</label>
                            </span>
                        </div>
                        <div>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="cosmeticRepair" name="reason"
                                                                                                       value="美容修复"/></span>
                                    <label class="required" for="cosmeticRepair">美容修复</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="periodontitis" name="reason"
                                                                                                       value="牙周病"/></span>
                                    <label class="required" for="periodontitis">牙周病</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="arrangement" name="reason"
                                                                                                       value="牙齿排列不齐"/></span>
                                    <label class="required" for="arrangement">牙齿排列不齐</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 requireds"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                       id="correct" name="reason"
                                                                                                       value="矫正调整"/></span>
                                    <label class="required" for="correct">矫正调整</label>
                            </span>
                            <span></span>
                        </div>
                    </div>
                </div>
                <div id="records_status">
                    <div>
                        <p>现在身体</p>
                        <p>状况</p>
                    </div>
                    <div>
                        <div>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="physicalCondition" id="good"
                                                                                                        value="良好"></span>
                                <label for="good" class="selection"
                                       style="">良好</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="physicalCondition" id="poor"
                                                                                                        value="不佳"></span>
                                <label for="poor" class="selection"
                                       style="">不佳</label>
                            </span>
                            <span></span>
                        </div>
                        <div>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="physicalCondition" id="pregnant"
                                                                                                        value="怀孕"></span>
                                <label for="pregnant" class="selection"
                                       style="">怀孕（&nbsp;&nbsp;）月</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="physicalCondition" id="andPregnant"
                                                                                                        value="怀孕有孕"></span>
                                <label for="andPregnant" class="selection" style="">怀疑有孕</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="physicalCondition" id="lactation"
                                                                                                        value="哺乳期"></span>
                                <label for="lactation" class="selection"
                                       style="">哺乳期（&nbsp;&nbsp;）月</label>
                            </span>
                        </div>
                    </div>
                </div>
                <div id="records_history">
                    <div>既往史</div>
                    <div>
                        <div>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="pastHistory"
                                                                                                        id="hematopathy" value="血液病"></span>
                                <label for="hematopathy" class="selection" style="">血液病</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="pastHistory"
                                                                                                        id="pacemaker" value="安装心脏起搏器"></span>
                                <label for="pacemaker" class="selection" style="">安装心脏起搏器</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="pastHistory"
                                                                                                        id="hyperthyroidism" value="甲亢"></span>
                                <label for="hyperthyroidism" class="selection"
                                       style="">甲亢</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="pastHistory"
                                                                                                        id="aids" value="艾滋病"></span>
                                <label for="aids" class="selection"
                                       style="">艾滋病</label>
                            </span>
                        </div>
                        <div>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="pastHistory"
                                                                                                        id="orthodontics" value="正畸矫正史"></span>
                                <label for="orthodontics" class="selection" style="">正畸矫正史</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="pastHistory"
                                                                                                        id="smoke" value="吸烟"></span>
                                <label for="smoke" class="selection"
                                       style="">吸烟一天 &nbsp;&nbsp;支</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="pastHistory"
                                                                                                        id="nephropathy" value="出血性疾病/肾病"></span>
                                <label for="nephropathy" class="selection" style="">出血性疾病/肾病</label>
                            </span>
                            <span></span>
                        </div>
                    </div>
                </div>
                <div id="records_allergy">
                    <div>过敏史</div>
                    <div>
                        <div>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="theHistory"
                                                                                                        id="penicillin" value="青霉素"></span>
                        <label for="penicillin" class="selection"
                               style="">青霉素</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="theHistory"
                                                                                                        id="sulfonamides" value="磺胺类"></span>
                        <label for="sulfonamides" class="selection"
                               style="">磺胺类</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="theHistory"
                                                                                                        id="other" value="其他"></span>
                        <label for="other" class="selection"
                               style="">其他</label>
                            </span>
                        </div>
                        <div>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="theHistory"
                                                                                                        id="seafood" value="海鲜"></span>
                        <label for="seafood" class="selection" style="">海鲜</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="theHistory"
                                                                                                        id="egg" value="鸡蛋"></span>
                        <label for="egg" class="selection" style="">鸡蛋</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="theHistory"
                                                                                                        id="mango" value="芒果"></span>
                        <label for="mango" class="selection" style="">芒果</label>
                            </span>

                        </div>
                    </div>
                </div>
                <div id="records_anaesthesia">
                    <div>
                        <p>是否注射</p>
                        <p>过局部麻醉</p>
                    </div>
                    <div>
                        <div>
                            <span>
                            <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                    name="anaesthesia"
                                                                                                    id="selectionYes" value="是"></span>
                            <label for="selectionYes" class="selection"
                                   style="">是：感觉不适</label>
                            </span>
                            <span>
                            <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                    name="anaesthesia"
                                                                                                    id="discomfort" value="没有不适"></span>
                            <label for="discomfort" class="selection"
                                   style="">没有不适</label>
                            </span>
                            <span></span>
                        </div>
                        <div>
                            <span>
                            <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                    name="anaesthesia"
                                                                                                    id="selectionNo" value="否"></span>
                        <label for="selectionNo" class="selection" style="">否</label>
                        </span>
                        </div>
                    </div>
                </div>
                <div id="records_requirement">
                    <div>对治疗的要求</div>
                    <div>
                        <div>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="frequency"
                                                                                                        id="anytime" value="任何时候"></span>
                            <label for="anytime" class="selection"
                                   style="">任何时候</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="frequency"
                                                                                                        id="longTime" value="次数少时间长"></span>
                            <label for="longTime" class="selection"
                                   style="">次数少时间长</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="frequency"
                                                                                                        id="shortTime" value="次数多时间短"></span>
                            <label for="shortTime" class="selection"
                                   style="">次数少时间长</label>
                            </span>
                        </div>
                        <div>
                            <span>
                                <span class="pay_list_c1 selections">
                                    <span class="aHook">✔</span>
                                    <input class="radioclass" type="radio" name="cost" id="economics" value="经济型">
                                </span>
                            <label for="economics" class="selection"
                                   style="">经济型</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio" name="cost"
                                                                                                        id="best" value="最好的治疗方法和材料"></span>
                            <label for="best" class="selection"
                                   style="">最好的治疗方法和材料</label>
                            </span>
                            <span></span>
                        </div>
                    </div>
                </div>
                <div id="records_source">
                    <div>选择我们的原因</div>
                    <div>
                        <div>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="treatment" value="社区义诊"></span>
                            <label for="treatment" class="selection"
                                   style="">社区义诊</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="network" value="网络"></span>
                            <label for="network" class="selection"
                                   style="">网络</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="weChat" value="微信"></span>
                            <label for="weChat" class="selection"
                                   style="">微信</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="newspaper" value="报纸"></span>
                            <label for="newspaper" class="selection"
                                   style="">报纸</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="elevator" value="电梯广告"></span>
                            <label for="elevator" class="selection"
                                   style="">电梯广告</label>
                            </span>
                        </div>
                        <div>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="outdoor" value="户外棚子"></span>
                            <label for="outdoor" class="selection"
                                   style="">户外棚子</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="leaflets" value="宣传单"></span>
                            <label for="leaflets" class="selection"
                                   style="">宣传单</label>
                            </span>

                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="expert" value="专家讲座"></span>
                            <label for="expert" class="selection"
                                   style="">专家讲座</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="cashCoupon" value="代金券"></span>
                            <label for="cashCoupon" class="selection"
                                   style="">代金券</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="dentist" value="小牙医"></span>
                            <label for="dentist" class="selection"
                                   style="">小牙医</label>
                            </span>
                        </div>
                        <div>

                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="american" value="美团"></span>
                            <label for="american" class="selection"
                                   style="">美团</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="nearby" value="附近的人"></span>
                            <label for="nearby" class="selection"
                                   style="">附近的人</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="introduction" value="朋友介绍"></span>
                            <label for="introduction" class="selection"
                                   style="">朋友介绍</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="passBy" value="路过"></span>
                            <label for="passBy" class="selection"
                                   style="">路过</label>
                            </span>
                        </div>
                        <div>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="callBack" value="电话回访"></span>
                            <label for="callBack" class="selection"
                                   style="">电话回访</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="beenHere" value="以前来过"></span>
                            <label for="beenHere" class="selection"
                                   style="">以前来过</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="cooperative" value="合作商家"></span>
                            <label for="cooperative" class="selection"
                                   style="">合作商家</label>
                            </span>
                            <span>
                                <span class="pay_list_c1 selections"><span class="aHook">✔</span><input class="radioclass" type="radio"
                                                                                                        name="selectReasons"
                                                                                                        id="cooperation" value="瑞尔合作"></span>
                            <label for="cooperation" class="selection"
                                   style="">瑞尔合作</label>
                            </span>
                        </div>
                    </div>
                </div>
            </div>
            <div id="patient">
                <h2>本人承诺以上填写内容均真实有效</h2>
                <div style="padding-bottom: 20px;display: inline-block;width: 50%" class="clearfix">
                    <span style="float: left">患者/法定监护人姓名：</span>
                    <span style="margin-left: 50px;">日期：<span>${customerInfo.createAppointmentTime}</span></span>
                </div>
            </div>
        </div>
    </div>
</div>
<!--endprint1-->
<div style="text-align: center;background: white;padding-bottom: 20px;">
    <button class="btn" type="button" onclick="preview(1)" value="点击打印">打印</button>
</div>

<script language="javascript">
    $(function () {
        var medicalReasons = $("#medicalReasonsValue").val();
        var selectReasons = $("#selectReasonsValue").val();
        $("input:radio[value='"+medicalReasons+"']").attr('checked','true').siblings('.aHook').show();
        $("input:radio[value='"+selectReasons+"']").attr('checked','true').siblings('.aHook').show();
    });

    function preview(oper) {
        if (oper < 10) {
            bdhtml = window.document.body.innerHTML;//获取当前页的html代码
            sprnstr = "<!--startprint" + oper + "-->";//设置打印开始区域
            eprnstr = "<!--endprint" + oper + "-->";//设置打印结束区域
            prnhtml = bdhtml.substring(bdhtml.indexOf(sprnstr) + 18); //从开始代码向后取html
            prnhtml = prnhtml.substring(0, prnhtml.indexOf(eprnstr));//从结束代码向前取html
            window.document.body.innerHTML = prnhtml;
            window.print();
            window.document.body.innerHTML = bdhtml;
        } else {
            window.print();
        }
    }
</script>
@}